key: cord-0846512-148q00q3
authors: Pérez-Granda, Maria Jesús; Carrillo, Carlos Sánchez; Rabadán, Pablo Martín; Valerio, Maricela; Olmedo, María; Muñoz, Patricia; Bouza, Emilio
title: INCREASE IN THE FREQUENCY OF CATHETER-RELATED BLOODSTREAM INFECTIONS DURING THE COVID-19 PANDEMIC: A PLEA FOR CONTROL
date: 2021-10-08
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2021.09.020
sha: cb4c47cc154c81ebe7ad83ea16c7dd47e551c885
doc_id: 846512
cord_uid: 148q00q3

INTRODUCTION: The incidence of nosocomial infections including ventilator-associated pneumonia and bacteraemia has been described during the COVID-19 pandemic. However, information regarding the impact of COVID-19 on the incidence of Catheter-Related bloodstream infections (CR-BSIs) is very limited. Our aim is to evaluate the impact of the COVID-19 pandemic in the evolution of CR-BSIs in a large hospital MATERIAL AND METHODS: Retrospective study comparing the incidence, aetiology and outcome of CR-BSIs during the months of March to May 2019 (pre-pandemic) and 2020 (during the pandemic). RESULTS: The number of patients with one or more CR-BSIs in 2019 and 2020 were 23 and 58 respectively (1.89 vs 5.53/ 1,000 admissions); p<0.001. Median time from catheter implantation to demonstration of CR-BSI was 27.5 days (range 11.75 to 126.00 days) in the 2019 cases and 16.0 days (range 11.00 to 23.50 days) in the 2020 population (p =0.032). CONCLUSION: A dramatic increase of CR-BSIs was found during the COVID-19 pandemic. Reinforcement of classic and new preventive measures are necessary.

Catheter-related infection is one of the leading causes of bacteremia and sepsis in 26 developed countries and its adequate control by multidisciplinary teams represents one of 27 the best quality indicators of an institution. The incidence can range from 0.8 to 18 28 episodes/1000 days of catheter exposure, depending on the type of patient, the type of 29 catheter and the care provided during implantation and follow-up. 1 . 2, 3 4, 5 . 30

The COVID-19 pandemic has led to a huge increase in the workload of hospitals 31 around the world and many patients have required long hospital stays including extended 32 admissions to Intensive Care Units (ICUs) 6-8 . 33 Care for these patients has been provided under strenuous circumstances, not only 34 because of the increased workload but also because sometimes there was a need to 35 implicate staff with a sub-optimal degree of training with ICU patients 9-11 . 36 Under these conditions, it is not surprising that an increased incidence of 37 nosocomially-acquired infections, including ventilator-associated pneumonia and 38 bacteremia, has been described in some centers [12] [13] [14] . Surprisingly, information regarding 39 the impact of COVID-19 on the incidence of Catheter-Related Bloodstream Infections 40 (CR-BSI) is minimal at the present time. 41

Our aim was to evaluate the impact of the COVID-19 pandemic in the evolution of 42 CR-BSIs in a large hospital, including incidence, etiology, and outcome. Our institution is a general reference hospital, located in Madrid, Spain with 1,350 beds 48 and approximately 55,000 admissions/year. The number of ICU beds is 70, that during the 49 study period were expanded to 140. 50

We performed a retrospective study in which we compared the incidence, etiology, and 52 outcome of CR-BSIs during the months of March-April-May in 2019 and 2020 (during the 53 COVID-19 pandemic). 54

The primary endpoint was the incidence of CR-BSI episodes before and during the 56 pandemic. 57

The secondary endpoints were the etiology and consequences of CR-BSI during the first 58 wave of the pandemic. The number of withdrawn catheters processed for culture in our laboratory was 302 92 Table II . In our study, the microorganisms causing CR-BSI were mainly Gram positive. 181

Other authors, analyzing the etiology of CLABSI in a COVID-19 cohort, reported that 182 53.3% were caused by Gram positive bacteria, followed by 26.7 % fungal and 20% Gram 183 negative bacteria 30 . 184

The main limitation of our study is that it was performed in a single hospital and 185 further studies with multicenter data would be welcome. While our study reflects findings 186 from a single hospital, we believe that it appropriately quantifies a problem that may well 187 have affected many centers throughout the world. 188

We hope that our findings will contribute to urge health professionals to All methods were carried out in accordance with relevant guidelines and regulations. 206 207

Availability of data and materials. All data generated or analysed during this study are 209 included in this article . 210

Competing interests. The authors declare no conflicts of interest. 211

(CB06/06/0058), Madrid, Spain; by grants from the ISCIII (PI20/00575) and the European 213

Regional Development Fund (FEDER) "A way of making Europe". 214

The funders had no role in the study design, data collection and analysis, decision to 215 publish, or preparation of the manuscript. Guan J o u r n a l P r e -p r o o f 

Inpatient 233 costs, mortality and 30-day re-admission in patients with central-line

Nori P, Cowman K, Chen V, et al. Bacterial